Carotid Artery Disease (CAD) is a condition where the carotid arteries become narrowed or blocked (‘occluded’) by a buildup of plaque that is made up of fatty deposits called atherosclerosis.

You have two main carotid arteries that run up the neck and then split into internal and external carotid arteries. The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.

Carotid Artery Disease is the result of the main carotid arteries becoming partially or fully blocked with this waxy plaque, preventing adequate blood flow to the brain.

Causes

Lifestyle conditions are mostly to blame for the damage caused to the arteries.

Major factors that contribute to this damage include:

• Smoking
• A history of smoking
• High levels of certain fats and cholesterol in the blood (hypercholesterolaemia)
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes

Symptoms

Carotid artery disease can go undetected (or be asymptomatic) until a problem develops like:

• Stroke
• Mini-stroke(TIA-transient ischemic attack)
• Visual disturbances (amaurosis fugax)
• Visual aura
• Temporary blindness (usually in one eye)
• One sided weaknesses
• Collapse/fainting
• Dizziness
• Tinnitus/ringing in the ears

Diagnosis

Doppler scan is the first stage screening test.

CT angiogram helps to confirm the percentage of stenosis accurately and also to  assess the blood circulation inside the brain

Treatment

Conservative management

• Monitor your symptoms and maintain regular visits
• Improving your fitness and leading a healthy lifestyle
• Control of cholesterol and sugar levels
• Quitting smoking

Intervention for significant disease

Two main methods for treating  are:

• Carotid Endarterectomy
• Carotid Stent Surgery

Carotid Endarterectomy

This is an open procedure that involves an admission into hospital for 3-4 days.
The surgeon makes a vertical or curved incision in the neck to isolate the affected carotid artery. The aim of this procedure is to clear the buildup from inside the artery, so the surgeon will clamp the artery, make an incision and clean out the waxy residue. The clean artery will then be sutured, sometimes with the addition of a ‘patch’ made from another vein or from a synthetic material, and finally, the neck incision will be closed.

Carotid Stent

Carotid Stenting is the insertion of a stent (a fine metal cylindrical scaffold) through a small incision in the groin. Special X-ray equipment and dye allow the surgeon to safely move the stent from your groin to your carotid artery in your neck. The stent is designed to keep the artery open and to trap any plaque. Stenting is minimally invasive. The surgeon will consider very carefully whether you have disease morphology that is suitable for stenting. Stenting procedure involves a filter device which helps to significantly reduced stroke during the procedure. Stenting is performed under angiographic control, with a local anaesthetic and sedation and usually takes approximately 2 hours. The hospital stay and admission is similar to the Carotid Endarterectomy.

After Treatment

Good management of lifestyle factors

Important to have ongoing surveillance with your doctor.

This will usually involve ultrasound of the carotid arteries, along with consultation. By doing this on a regular basis, you and your doctor can identify if your disease is recurring or progressing and offer adjustments to your treatment.